Study in New England Journal of Medicine: Colonoscopy saves lives

(Press-News.org) Bethesda, MD (Sept. 18, 2013) — A study published in the Sept. 19 New England Journal of Medicine provides some of the clearest evidence to date that colonoscopy has advantages over sigmoidoscopy for the prevention of colorectal cancer.

Researchers followed 88,902 study participants for 22 years and found that 1,815 developed colorectal cancer. Investigators estimated that 40 percent of those cancers could have been prevented if all of the patients in the study had received colonoscopy.

"Thanks to colonoscopy, fewer people than ever before are developing or dying from colorectal cancer," said Anil K. Rustgi, MD, AGAF, president of the American Gastroenterological Association (AGA) Institute.

"Gastroenterologists, the specialists who screen for colorectal cancer, are proud of our role in this public health success story," added Ronald J. Vender, MD, FACG, president of the American College of Gastroenterology.

Screening is recommended starting at age 50 for people who are at average risk for colorectal cancer. There are many screening options, including the two used in this study: sigmoidoscopy (every five years), which reaches the lower third of the colon, and colonoscopy (every 10 years), which reaches the entire colon. Read full screening guidelines.

When comparing mortality rates in this study, researchers found that only colonoscopy was associated with reduced death from cancer in the proximal colon — the first part of the colon that physicians can see only via colonoscopy. Promixal colorectal cancer is more common in African Americans than whites1.

"Proximal colorectal cancers are associated with worse survival odds2. Colonoscopy allows gastroenterologists to not only visualize this hard-to-reach area of the body, but to remove pre-cancerous polyps, preventing a deadly disease," said Kenneth K. Wang, MD, FASGE, president of the American Society for Gastrointestinal Endoscopy.

Of the more than 50,000 people expected to die of colorectal cancer in 2013, screening could have saved more than half of them3.

Researchers with the Dana-Farber Cancer Institute, Harvard Medical School, Brigham and Women's Hospital, Massachusetts General Hospital, University of Aberdeen (UK), University of Tokyo Hospital and the National Institutes of Health (National Cancer Institute) analyzed information from the Nurses' Health Study and the Health Professionals Follow-up Study, which gather comprehensive health information from participants every two years. Study citation: Nishihara R, Wu K, Lochhead MB, et al. Long-Term Colorectal-Cancer Incidence and Mortality after Lower Endoscopy. N Engl J Med 2013;369:1095-105.

### About the American College of Gastroenterology Founded in 1932, the American College of Gastroenterology (ACG) is an organization with an international membership of more than 12,000 individuals from 80 countries. The College is committed to serving the clinically oriented digestive disease specialist through its emphasis on scholarly practice, teaching and research. The mission of the College is to serve the evolving needs of physicians in the delivery of high quality, scientifically sound, humanistic, ethical, and cost-effective health care to gastroenterology patients. http://www.gi.org

About the AGA Institute The American Gastroenterological Association is the trusted voice of the GI community. Founded in 1897, the AGA has grown to include 17,000 members from around the globe who are involved in all aspects of the science, practice and advancement of gastroenterology. The AGA Institute administers the practice, research and educational programs of the organization. http://www.gastro.org.

About the American Society for Gastrointestinal Endoscopy Since its founding in 1941, the American Society for Gastrointestinal Endoscopy (ASGE) has been dedicated to advancing patient care and digestive health by promoting excellence and innovation in gastrointestinal endoscopy. ASGE, with more than 12,000 members worldwide, promotes the highest standards for endoscopic training and practice, fosters endoscopic research, recognizes distinguished contributions to endoscopy, and is the foremost resource for endoscopic education. Visit http://www.asge.org and http://www.screen4coloncancer.org for more information and to find a qualified doctor in your area.

1 Am J Gastroenterol. 2005 Mar;100(3):515-23; discussion 514
2 Wong RJ Gen Intern Med. 2010 Nov;25(11):1157-63. doi: 10.1007/s11606-010-1460-4.
3 ACS: Cancer Prevention & Early Detection Facts & Figures 2013